From the Guidelines
Herpes ophthalmicus treatment should prioritize oral antiviral medications, such as acyclovir (200 to 400 mg five times a day), valacyclovir (500 mg two or three times a day), or famciclovir (250 mg twice a day), to reduce the risk of complications and improve outcomes. When considering treatment options, it is essential to weigh the potential benefits and risks of each medication. For instance, topical trifluridine 1% solution may be effective, but it can cause epithelial toxicity if used for more than 2 weeks 1. In contrast, topical ganciclovir 0.15% gel is less toxic to the ocular surface and can be used three to five times per day 1. Key considerations in treatment include:
- The importance of starting treatment promptly, ideally upon high suspicion or concomitant corneal involvement 1
- The need for regular follow-up, including an interval history, visual acuity measurement, and slit-lamp biomicroscopy within 1 week of treatment 1
- The potential for lower doses of oral antivirals to be effective for long-term prophylaxis against recurrent HSV conjunctivitis and keratitis 1
- The importance of avoiding topical corticosteroids, which can potentiate HSV epithelial infections 1 By prioritizing oral antiviral medications and considering these key factors, patients with herpes ophthalmicus can receive effective treatment and reduce their risk of complications.
From the Research
Treatment Options for Herpes Ophthalmicus
- Herpes zoster ophthalmicus is a condition that affects the eye and vision, caused by the reactivation of the varicella zoster virus in the distribution of the first division of the trigeminal nerve 2, 3.
- The standard first-line treatment for herpes zoster ophthalmicus infections is an aggressive management with systemic antiviral medication, such as acyclovir and its prodrug valacyclovir 2, 4, 5.
Comparison of Valacyclovir and Acyclovir
- Studies have compared the efficacy and safety of valacyclovir and acyclovir for the treatment of herpes zoster ophthalmicus, with results showing that valacyclovir is as effective as acyclovir in preventing ocular complications 4.
- The dosing schedule of valacyclovir is simpler, and its tolerability is similar to that of acyclovir 4.
- However, the certainty of evidence for the use of valacyclovir compared to acyclovir is rated as low to very low due to concerns about imprecision and study limitations 2.
Duration of Treatment
- A study found that a 7-day course of oral acyclovir was sufficient for the treatment of herpes zoster ophthalmicus, and prolonging treatment for more than 7 days did not show significant differences in outcomes 5.
Prevention of Recurrent Herpes Simplex Virus Eye Disease
- A pilot study compared the efficacy of valacyclovir and acyclovir in preventing recurrence of herpes simplex virus eye disease, and found that one-year suppression therapy with oral valacyclovir was as effective and well-tolerated as acyclovir in reducing the rate of recurrent ocular HSV disease 6.